Abortion and mental health

The relationship between induced abortion and mental health is an area of political controversy.[1][2] Major medical bodies have found that induced abortions do not cause mental-health problems, and that the risk of mental-health problems is equal whether an unplanned pregnancy is carried to term or terminated via abortion.[3][4] Pre-existing factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.[5][6][7]

In 1990, the American Psychological Association (APA) found that "severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses."[8] The APA updated its findings in August 2008 to account for new evidence, and again concluded that termination of a first unplanned pregnancy did not increase the risk of mental-health problems.[3][9] A 2008 systematic review of the medical literature on abortion and mental health found that high-quality studies consistently showed few or no mental-health consequences of abortion, while poor-quality studies were more likely to report negative consequences.[10] In December 2011, the U.K. National Collaborating Centre for Mental Health published a systematic review of available evidence, similarly concluding that abortion did not increase the risk of mental-health problems.[4][11]

Despite the weight of medical opinion on the subject, some pro-life advocacy groups have continued to allege a link between abortion and mental-health problems.[12] Some pro-life groups have used the term "post-abortion syndrome" to refer to negative psychological effects which they attribute to abortion. However, "post-abortion syndrome" is not recognized as an actual syndrome by the American Psychological Association, the American Psychiatric Association,[13] or the Royal College of Obstetricians and Gynaecologists;[14]physicians and pro-choice advocates have argued that the effort to popularize the idea of a "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.[1][12][15][16] Some U.S. state legislatures have mandated that patients be told that abortion increases their risk of depression and suicide, despite the fact that such risks are not supported by the bulk of the scientific literature.[10][17]

Systematic reviews of the scientific literature have concluded that there are no differences in the long-term mental health of women who obtain induced abortions as compared to women in appropriate control groups.[10] While some studies have reported a statistical correlation between abortion and clinical depression, anxiety, suicidal behaviors, or adverse effects on women's sexual functions for a small number of women, these studies are typically methodologically flawed and fail to account for confounding factors. Higher-quality studies have consistently found no causal relationship between abortion and mental-health problems.[10] The correlations observed in some studies may be explained by pre-existing social circumstances and emotional health.[18] Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortion, may increase the likelihood of experiencing negative reactions. However, negative consequences[19] on mental health can be due to any pregnancy outcome.[20]

In 1987, President Ronald Reagan directed U.S. Surgeon GeneralC. Everett Koop, an evangelical Christian and abortion opponent,[21] to issue a report on the health effects of abortion. Reportedly, the idea for the review was conceived by Reagan advisors Dinesh D'Souza and Gary Bauer as a means of "rejuvenat[ing]" the pro-life movement by producing evidence of the risks of abortion.[22] Koop was reluctant to accept the assignment, believing that Reagan was more concerned with appeasing his political base than with improving women's health.[21]

Ultimately, Koop reviewed over 250 studies pertaining to the psychological impact of abortion. Koop wrote in a letter to Reagan that "scientific studies do not provide conclusive data about the health effects of abortion on women."[23] Koop acknowledged the political context of the question in his letter, writing: "In the minds of some of [Reagan's advisors], it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of Roe vs. Wade."[24]

In later testimony before the United States Congress, Koop stated that the quality of existing evidence was too poor to prepare a report "that could withstand scientific and statistical scrutiny." Koop noted that "... there is no doubt about the fact that some people have severe psychological effects after abortion, but anecdotes do not make good scientific material."[24] In his congressional testimony, Koop stated that while psychological responses to abortion may be "overwhelming" in individual cases, the psychological risks of abortion were "minuscule from a public health perspective."[1][5][22][25]

Subsequently, a Congressional committee charged that Koop refused to publish the results of his review because he failed to find evidence that abortion was harmful, and that Koop watered down his findings in his letter to Reagan by claiming that the studies were inconclusive. Congressman Theodore S. Weiss (D-NY), who oversaw the investigation, argued that when Koop found no evidence that abortion was harmful, he "decided not to issue a report, but instead to write a letter to the president which would be sufficiently vague as to avoid supporting the pro-choice position that abortion is safe for women."[25]

The American Psychological Association prepared a literature summary and recommendations for Koop's report. After Koop refused to issue their findings, the APA panel published them in the journal Science, concluding:

Although there may be sensations of regret, sadness, or guilt, the weight of the evidence from scientific studies indicates that legal abortion of an unwanted pregnancy in the first trimester does not pose a psychological hazard for most women...

Women who are terminating pregnancies that are wanted and personally meaningful, who lack support from their partner or parents for the abortion, who have more conflicting feelings, or who are less sure of their decision beforehand may be a relatively higher risk for negative consequences.[5]

The APA task force also concluded that "severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress."[5] Nancy Adler, a professor of psychology at the University of California, San Francisco, testified on behalf of the APA that "severe negative reactions are rare and are in line with those following other normal life stresses."[8][26]

In 2007, APA established a new task force to review studies on abortion published since 1989.[1] The APA task force issued an updated summary of medical evidence in August 2008, again concluding that a single first-trimester abortion carried no more mental health risk than carrying a pregnancy to term. The panel noted a lack of quality data on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predipose her to mental health difficulties; therefore, they declined to draw a firm conclusion on multiple abortions.[3][9]

In 2008, a team at Johns Hopkins University conducted a systematic review of the medical literature, concluding that "the best quality studies indicate no significant differences in long-term mental health between women in the United States who choose to terminate a pregnancy and those who do not."[10][27] Robert Blum, the senior author of the study, stated: "The best research does not support the existence of a 'post-abortion syndrome' similar to post-traumatic stress disorder." The researchers further reported that "... studies with the most flawed methodology consistently found negative mental health consequences of abortion", and they wrote: "Scientists are still conducting research to answer politically motivated questions."

The term "post-abortion syndrome" ("PAS") has subsequently been popularized and widely used by pro-life advocates to describe a broad range of adverse emotional reactions which they attribute to abortion.[1][15][30] "Post-abortion syndrome" has not found widespread acceptance outside the pro-life community; the American Psychological Association and the American Psychiatric Association do not recognize PAS as an actual diagnosis or condition, and it is not included in the Diagnostic and Statistical Manual of Mental DisordersDSM-IV-TR or in the ICD-10 list of psychiatric conditions. Some physicians and pro-choice advocates have argued that the focus on "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.[12][16][31][32]

^ abcStotland NL (2003). "Abortion and psychiatric practice". J Psychiatr Pract9 (2): 139–49. doi:10.1097/00131746-200303000-00005. PMID15985924."Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae."